Lymphedematous Fibroepithelial Polyp Without Associated Condom Catheter Use: A Case Report With Review of the Literature.

ABSTRACT: Lymphedematous fibroepithelial polyps are rare proliferations involving the glans penis typically associated with chronic condom catheter usage. To the best of our knowledge, less than 20 cases have been reported in the literature with relatively similar clinical presentation. Herein, we report a case of lymphedematous fibroepithelial polyp not associated with condom usage in a 74-year-old man treated with surgical excision. On histopathological examination, the lesion displayed a hypocellular proliferation of spindled and stellate fibroblasts with intermixed Touton-like giant cells embedded within an edematous stroma with thickened vasculature. Immunohistochemical profiling exhibits strong immunoreactivity for smooth muscle actin, weak positivity for factor XIIIa, and no reactivity for CD34 or desmin. We also conducted a review of the reported range of clinical and histopathological features of this entity in addition to the various hypotheses regarding its pathogenesis. We hope to increase awareness and accurate diagnosis of this entity, which could affect clinical management.

Condom-Associated Erectile Function, But Not Other Domains of Sexual Functioning, Predicts Condomless Insertive Anal Sex Among Young Men Who Have Sex with Men.

Condoms effectively prevent against HIV, especially when used in conjunction with biomedical strategies such as PrEP and viral suppression. However, consistent use of condoms in the real world has been a continual health promotion challenge, even among populations at highest risk, such as young men who have sex with men (YMSM). Inconsistent condom use may be related to poor sexual functioning, but limited research exists. The analytic sample comprised 688 racially diverse YMSM aged 16-29 (M = 22.9 years) living in Chicago, IL (19.2% living with HIV). Using multivariable logistic regression, we examined longitudinal associations between condom-associated sexual functioning (erectile function, orgasm satisfaction, global satisfaction, and anal discomfort) and condomless insertive anal sex (CIAS) and condomless receptive anal sex (CRAS) 6 months later. CIAS at Time 2 was associated with condom-associated erectile function at the bivariate and multivariable levels, even after controlling for CIAS at Time 1 (p < .05). Condom-associated erectile function, orgasm satisfaction, and global satisfaction predicted Time 2 CRAS in bivariate models, but none remained significant in the multivariable models. Age, having had a serious partner in the past 6 months, and HIV/PrEP status at Time 2 were significant predictors of CIAS/CRAS in some but not all models. Future interventions to improve consistent condom use should specifically highlight information and skills on how to use condoms within real-world contexts rather than from a clinical perspective. Our results also support the importance of biomedical strategies for those who have continued problems with sexual functioning when using condoms.

Consumer protection provided by the European medical device and cosmetic legislation for condoms and lubricants.

Personal lubricants and lubricants used in condoms contain a number of ingredients which are also present in cosmetic products. These have to comply to the medical device regulation (745/2017) which should provide the same level of consumer protection, if not more, as foreseen in the legal framework of cosmetics (1223/2009). In the current study we developed an analytical method capable of identifying and quantifying 15 ingredients, commonly found in lubricants and cosmetics. Based upon their most important toxicological endpoint, the substances involved were grouped in three toxicological classes provoking either irritation, contact allergic dermatitis or systemic toxicity. The method was applied on 30 condoms and 54 personal lubricants present on the EU market. Their safety was assessed using the same reasoning as commonly applied for cosmetic ingredients. Higher mucosae susceptibility, the main exposed area for lubricants, was taken into account in this assessment. The results show that the majority of the products studied are safe. Nevertheless, for some products the safety could not be confirmed. The results also highlight the fact that there is no consensus for a number of ingredients, used as well in cosmetics as in medical devices. Alignment between both legislations would improve the safety of these products and further raise the general level of consumer protection.

Sexual experiences and quality of life in Turkish women using methods of contraception.

The aim of this study was to examine the sexual experiences and quality of life in women using methods of contraception. The sample of this descriptive study consisted of 259 women. The data were collected by the Personal Information Form, the Arizona Sexual Experiences Scale (ASES) and the World Health Organisation Quality of Life Scale (WHOQOL-BREF). It was found that 35.1% of the women use condoms, 30.1% of them use the Intrauterine Device (IUD), 22.0% had problems using the method and 39% had the side effects while using the method. There was a statistically significant difference between the state of having problems using the methods and quality of life average scores and between the state of having side effects and sexual life and quality of life average scores (p < .05). Impact statement What is already known on this subject? Sexual problems are common health problems among women and can lead to loss of self-esteem in women, depression and emotional stress. What do the results of this study add? Women who experience problems using a contraception method have a lower quality of life. Sexual dysfunctions were higher among those who experienced side effects of the methods, quality of life scores were lower. What are the implications of these findings for clinical practice and/or further research? Health professionals should provide information and counselling about possible problems or side effects and ways to cope with these problems or side effects.

Emergency contraception and risk habits in a university population.

OBJECTIVE: The aim of our study was to determine the self-reported prevalence of use of emergency contraception (EC), identify factors associated with EC use, and measure the prevalence in university students of pregnancy and abortion among users and non-users of EC. METHODS: A cross-sectional descriptive study of university students using a self-administered questionnaire was carried out in 2016. The main dependent variable was EC use at any time. Independent variables included sociodemographic factors and factors related to harmful habits and sexual behaviour. RESULTS: The study sample consisted of 1309 students (median age 20 years). Forty per cent of participants reported using EC; condom failure was given as the main reason. Variables associated with EC use in both men and women were illegal drug consumption and having had more than 10 sexual partners. In women, other factors associated with EC use were age at first coitus and non-centrist political views. The prevalence of pregnancy was 6.5% and the prevalence of voluntary abortion was 2.9%. This prevalence was similar for men and women and for EC users and non-users. CONCLUSION: EC use in university students was more likely in those who experienced contraceptive failure or used no contraception. There were differences between men and women. Those at higher risk of unplanned pregnancy were more likely to report EC use, which may explain why there was no difference in the rates of unwanted pregnancies between EC users and non-users.

Risky Business: condom failures as experienced by female sex workers in Mombasa, Kenya.

Limited research exists about condom failure as experienced by female sex workers. We conducted a qualitative study to examine how female sex workers in Mombasa, Kenya contextualise and explain the occurrence of condom failure. In-depth, semi-structured interviews were conducted with thirty female sex workers to ascertain their condom failure experiences. We qualitatively analysed interview transcripts to determine how the women mitigate risk and cope with condom failure. Condom failure was not uncommon, but women mitigated the risk by learning about correct use, and by supplying and applying condoms themselves. Many female sex workers felt that men intentionally rupture condoms. Few women were aware of or felt empowered to prevent HIV, STIs, and pregnancy after condom failure. Interventions to equip female sex workers with strategies for minimising the risk of HIV, STIs, and pregnancy in the aftermath of a condom failure should be investigated.

A Daily Diary Analysis of Condom Breakage and Slippage During Vaginal Sex or Anal Sex Among Adolescent Women.

BACKGROUND: Adolescent women are disproportionately impacted by the adverse outcomes associated with sexual activity, including sexually transmitted infections (STI). Condoms as a means of prevention relies on use that is free of usage failure, including breakage and/or slippage. This study examined the daily prevalence of and predictors of condom breakage and/or slippage during vaginal sex and during anal sex among adolescent women. METHODS: Adolescent women (N = 387; 14 to 17 years) were recruited from primary care clinics for a longitudinal cohort study of STIs and sexual behavior. Data were daily partner-specific sexual diaries. Random intercept mixed-effects logistic regression was used to estimate the fixed effect of each predictor on condom breakage/slippage during vaginal or during anal sex (Stata, 13.0), adjusting model coefficients for the correlation between repeated within-participant diary entries. RESULTS: Condom slippage and/or breakage varied across sexual behaviors and was associated with individual-specific (eg, age and sexual interest) and partner-specific factors (eg, negativity). Recent behavioral factors (eg, experiencing slippage and/or breakage in the past week) were the strongest predictors of current condom slippage and/or breakage during vaginal or anal sex. CONCLUSIONS: Factors associated with young women's condom breakage/slippage during vaginal or during anal sex should be integrated as part of STI prevention efforts and should be assessed as part of ongoing routine clinical care.

Who's that girl? A qualitative analysis of adolescent girls' views on factors associated with teenage pregnancies in Bolgatanga, Ghana.

BACKGROUND: Adolescent pregnancy remains a public health concern, with diverse serious consequences, including increased health risk for mother and child, lost opportunities for personal development, social exclusion, and low socioeconomic attainments. Especially in Africa, teenage pregnancy rates are high. It is important to find out how girls without pregnancy experience differ in their contraceptive decision-making processes as compared with their previously studied peers with pregnancy experience to address the high rate of teenage pregnancies. METHODS: We conducted semi-structured in-depth interviews with never been pregnant girls (N = 20) in Bolgatanga, Ghana, to explore the psychosocial and environmental factors influencing the sexual decision making of adolescents. Themes such as relationships, sex, pregnancy, family planning and psychosocial determinants (knowledge, attitudes, self-efficacy, norms, risk perceptions) derived from empirical studies and theories related to sexuality behavior guided the development of the interview protocol. RESULTS: Results showed that the girls did talk about sexuality with their mothers at home and did receive some form of sexual and reproductive health education, including the use of condoms discussions in school. Participants reported high awareness of pregnancy risk related to unprotected sex, were positive about using condoms and indicated strong self-efficacy beliefs towards negotiating condom use. The girls also formulated clear future goals, including coping plans such as ways to prevent unwanted pregnancies to reach these targets. On the other hand, their attitudes towards family planning (i.e., contraceptives other than condoms) were negative, and they hold boys responsible for buying condoms. CONCLUSION: An open parental communication on sexuality issues at home, comprehensive sex education in school and attitude, self-efficacy, risk perception towards contraception, alongside with goal-setting, seem to be protective factors in adolescent girls' pregnancy prevention efforts. These factors should be targets in future intervention programs at the individual, interpersonal, and school and community levels.

Spermiotoxicity of commercial condoms made from polyurethane, polyisoprene and latex, using domestic ruminants as an experimental animal model.

The use of condoms could provide a means of collecting high-quality spermatozoa from different species under physiological ejaculation conditions. However, certain condom materials may affect sperm functionality. This study examined the spermiotoxicity of different commercial condom materials towards ram and goat spermatozoa. Sperm samples were diluted in Tyrode's medium and placed in contact with a piece of condom material (polyurethane, polyisoprene or latex) and incubated for 30 or 90 min. Contact time in the polyisoprene and latex treatments affected some sperm variables; no such effects were seen, however, in the polyurethane treatments. For ram spermatozoa in contact with polyisoprene, the percentage of dead spermatozoa with a damaged acrosome increased at 90 min, while for spermatozoa in contact with latex, the percentage of live spermatozoa with an intact acrosome decreased. For goat spermatozoa in contact with both polyisoprene and latex, the percentage of dead spermatozoa with a damaged acrosome increased at 90 min, while for spermatozoa in contact with polyisoprene, the percentage of live spermatozoa with an intact acrosome decreased. In conclusion, latex and polyisoprene contain components that affect sperm motility, plasma membrane integrity and acrosome function. Polyurethane does not seem to reduce the quality of semen.

General Erectile Functioning among Young, Heterosexual Men Who Do and Do Not Report Condom-Associated Erection Problems (CAEP).

INTRODUCTION: Condom-associated erection problems (CAEP) are an underestimated factor related to inconsistent or incomplete male condom use. The underlying mechanisms of CAEP are not understood, and whether men who report these difficulties are also likely to experience erectile problems in situations when condoms are not used has not been studied. AIM: The aim of the study was to investigate, in a sample of condom-using young, heterosexual men (aged 18-24 years), whether men who report CAEP are more likely to (i) have erection problems when not using condoms and (ii) meet criteria for erectile dysfunction. METHODS: A total of 479 men recruited online completed the International Index of Erectile Function (IIEF-5) and answered questions about erection problems experienced when using and not using condoms during the last 90 days. Demographic, sexual experience, and health status variables were investigated as correlates. MAIN OUTCOME MEASURES: Self-reported frequency of erection loss during condom application or during penile-vaginal intercourse (PVI) in the past 90 days and IIEF-5 scores. RESULTS: Of the men, 38.4% were classified in the no CAEP group, 13.8% as having CAEP during condom application, 15.7% as having CAEP during PVI, and 32.2% as having CAEP during both condom application and PVI. Men reporting any form of CAEP were significantly more likely than men reporting no CAEP to also report erection difficulties during sexual activity when not using condoms. Men who reported CAEP during PVI only or during both application and PVI scored significantly lower on the IIEF-5 than men without CAEP. CONCLUSION: The findings suggest that men who report CAEP are also more likely to experience more generalized erection difficulties. Clinicians should assess whether men using condoms experience CAEP and where appropriate, refer for psychosexual therapy or provide condom skills education.

Patterns of sexual arousal in young, heterosexual men who experience condom-associated erection problems (CAEP).

INTRODUCTION: Condom-associated erection problems (CAEPs) are reported by a substantial number of young men and are associated with inconsistent and/or incomplete condom use. The underlying mechanisms of CAEP are not well understood, and research examining the possibility that men who report CAEP differ from other men in their sexual responsivity is lacking. AIM: This study used psychophysiological methods to examine whether men who report CAEP have a higher threshold for sexual arousal, a stronger need for tactile stimulation, and/or more easily lose their sexual arousal due to neutral distractors or performance-related demands. METHODS: A total of 142 young, heterosexual men (53% reporting CAEP) were presented with four 3-minute erotic film clips. Three film clips were combined with one of the following manipulations: (i) distraction; (ii) performance demand; or (iii) vibrotactile stimulation. One erotic film clip was presented with no further instructions or manipulations. MAIN OUTCOME MEASURES: Average penile circumference changes during the first, second, and third minute (time) of the erotic film stimuli (condition) were submitted to a mixed-model analysis of variance with condition and time as within-subjects factors and group (CAEP/no-CAEP) as between-subjects factor. RESULTS: Significant main effects of condition and time and a significant interaction of group × time were found. No significant interactions involving condition were found. Men who reported CAEP had smaller erectile responses during the first minute, regardless of film condition, than men who reported no CAEP (F(1,141) = 8.64, P < 0.005). CONCLUSION: The findings suggest that men with and without CAEP differ in the ease with which they become sexually aroused. Men reporting CAEP needed more time and/or more intense stimulation to become aroused. To our knowledge, this study is the first to use psychophysiological methods to assess sexual responsivity in men who report CAEP.

Correlates of condom-associated erection problems in young, heterosexual men: condom fit, self-efficacy, perceptions, and motivations.

Questionnaire data from 479 heterosexual men 18-24 years old were analyzed for correlates of CAEP during application (CAEP-Application) and CAEP during penile-vaginal intercourse (CAEP-PVI). Potential correlates were self-efficacy (condom application, product selection, and maintaining arousal), condom perceptions (condom worry/distraction, negative condom perceptions, concerns about application speed), condom fit, and motivation to use condoms. We conclude that (1) experiencing CAEP may become a repeating cycle, both affecting and being affected by, worry and distraction related to losing erections and maintaining arousal while using a condom (2) poorly fitting condoms may contribute to CAEP, and (3) CAEP may decrease motivation to use condoms.

[Features of the incidence of cystitis depending on the type of contraception].

For the purpose of evaluation the effect of contraceptive methods on the incidence of recurrent bacterial cystitis in women, 215 clinical records of patients with cystitis were analyzed. In addition, incidence of recurrent cystitis in three groups of sexually active women of reproductive age was compared: 26 patients (Group 1) received conventional therapy and used condom as a method of contraception; 31 patients (Group 2) received combined oral contraceptives (COC), and 32 patients (Group 3) received COC and two courses of treatment with canephrone. A negative correlation between COC use and the risk of cystitis was detected. After conventional therapy, recurrences were observed in 43.3% of patients in Group 1, in 25.8% of patients in Group 2, and only in 15.6% of women in Group 3. Thus, the choice of COCs for contraception lead to 2-fold reduction of risk of recurrence of bacterial cystitis, and additional use of canephrone--to 3-fold reduction.

Penile gangrene due to improper application of a condom catheter: a case report.

BACKGROUND: Fournier's gangrene is a rare, fulminant, and usually localized necrotizing soft tissue polymicrobial infection of the perineum, with occasional extension up to the abdominal wall. CASE PRESENTATION: We describe an unusual case of penile gangrene in a 64-year-old Tunisian man suffering from urinary incontinence secondary to cerebrovascular accident. Gangrene developed due to continuous tourniquet effect on the penis caused by a condom catheter. Although source control was achieved with aggressive debridement, careful wound care, and wide-spectrum antibiotherapy, the patient died due to septic shock. CONCLUSION: Use of condom catheters is not without complications. Careful placement, strict hygiene, and regular monitoring of the local condition are necessary.

A prospective event-level analysis of condom use experiences following STI testing among patients in three US cities.

BACKGROUND: This study prospectively assessed and compared the incidence of condom use errors/problems among clinic patients testing positive for one or more of 3 sexually transmitted diseases (STDs) and those testing negative. The study also identified event-level condom use errors associated with condom breakage and slippage during sex. METHODS: Enrolled clinic patients (N = 928) were tested for 3 STDs, then patients electronically recorded sexual intercourse and condom use behaviors daily for up to 6 months. Data were available on condom use errors and problems for the >10,000 sex events involving condoms. Assessed errors/problems were as follows: (1) not using a new condom, (2) allowing condoms to contact sharp objects, (3) not using condoms from start to finish of sex, (4) condoms drying out, (5) erection loss during condom use, (6) breakage, (7) slippage during sex, and (8) slippage after sex. Because the event-level measures were correlated within individual, generalized estimation equation models were used for analyses. RESULTS: All 8 forms of errors/problems with condom use occurred, with varying levels of frequency, without significant differences by baseline STD status for either men or women. Condom breakage was associated with contact with sharp objects (P < 0.0001) and drying out (P < 0.0001). Slippage during sex was associated with erection loss (P < 0.0001) and drying out (P < 0.0001). CONCLUSION: Subsequent to STD evaluation, much of the sex occurring with the use of a condom may not confer adequate protection. Problems found to be associated with condom breakage and slippage are potentially amenable to counseling interventions.

The feasibility of using mobile phone technology for sexual behaviour research in a population vulnerable to HIV: a prospective survey with female sex workers in South India.

Sexual behaviour studies are often challenged by sampling, participation and measurement biases, and may be unacceptable to participants. We invited 293 randomly selected female sex workers (FSWs) in Bangalore, India, to participate in a telephone survey, with condom breakage as the main outcome. Free cell phones were supplied and trained interviewers telephoned FSWs daily to ask about all sex acts the previous day. Later, we undertook focus groups to discuss the methodology with the participants. We evaluated technical and operational feasibility; data reliability and measurement error; emotional and fatigue effects; interviewer bias; survey reactivity effects; and user acceptability. Response rates were high, with 84% of invited participants complying fully with the protocol. The study ran smoothly, with little evidence of biases. The methodology was highly acceptable; the respondents enjoyed using a new telephone and being interviewed at times convenient to them. Other reasons for the success of the method were that the study was sanctioned and supported by the sex worker collective, and the interviewers were well trained and developed a strong rapport with the participants. The success of this methodology, and the wealth of data produced, indicates that it can be an important tool for conducting sexual behaviour research in low literacy, high sex volume populations.

Does it fit okay? Problems with condom use as a function of self-reported poor fit.

OBJECTIVE: To identify associations between men's self-reports of ill-fitting condoms and selected condom use problems, using an event-specific analysis. METHODS: A convenience sample of men was recruited via advertisements in newspapers (two urban and one small town) and a blog on the website of a condom sales company. Men completed a questionnaire posted on the website of The Kinsey Institute for Research in Sex, Gender, and Reproduction. Inclusion criteria were: at least 18 years old, used condoms for penile-vaginal intercourse in the past 3 months and the ability to read English. RESULTS: In controlled, event-specific, analyses of 436 men, those reporting ill-fitting condoms (44.7%) were significantly more likely to report breakage (adjusted odds ratio (AOR 2.6), slippage (AOR 2.7), difficulty reaching orgasm, both for their female partners (AOR 1.9) and for themselves (AOR 2.3). In addition, they were more likely to report irritation of the penis (AOR 5.0) and reduced sexual pleasure, both for their female partner (AOR 1.6) and for themselves (AOR 2.4). Furthermore, they were more likely to report that condoms interfered with erection (AOR 2.0), caused erection loss (AOR 2.3), or became dry during sex (AOR 1.9). Finally, they were more likely to report removing condoms before penile-vaginal sex ended (AOR 2.0). CONCLUSIONS: Men and their female sex partners may benefit from public health efforts designed to promote the improved fit of condoms.

Anogenital Dermatitis in Men Who Have Sex with Men.

Evaluation of anogenital dermatitis requires a detailed history, including a sexual history. Men who have sex with men have different risk of certain infectious causes compared with men who have sex with women. Infectious causes of balanitis and anal dermatitis are easily treatable once identified. Irritant contact dermatitis is a common cause of balanitis, and avoidance of irritants, including decreased soap washing, helps many patients improve. Detailed histories of the personal products used by the patient and partner(s), including soaps, lotions, perfumes, lubricants, condoms, topical medications, hygiene sprays, personal wipes, and laundry detergent, may reveal possible irritants or contact allergens.

Development of Novel Male Contraceptives.

Unintended pregnancy is surprisingly common, accounting for 40-50% of pregnancies worldwide. Contraception is the most effective means of preventing unintended pregnancy. Seventy percent of all contraceptives are used by women; however, some women are unable to use contraceptives due to health conditions or side effects. Many men wish to take a more active role family planning, but currently have only two effective male contraceptive options, condoms and vasectomy. Therefore, work to develop novel male contraceptives analogous to popular female methods, such as daily pills or long-acting shots and implants, is underway. This paper will briefly discuss the pros and cons of condoms and vasectomies, and then review the research into novel methods of male contraception.